1
|
Moore MS, Vo EH, Bhattarai B, Farley JH, Monk BJ, Willmott LJ, Chase DM. Robotic-assisted gynecologic surgery in an older population: A comparison study. J Geriatr Oncol 2023; 14:101533. [PMID: 37295288 DOI: 10.1016/j.jgo.2023.101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/04/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Robotic-assisted surgery in select patients has been shown to result in less peri-operative morbidity. Few studies have explored the association of robotic-assisted gynecology oncology surgery complication rates and increasing age. Our objective was to evaluate the peri- and postoperative complication rates in patients age 65 years or above in minimally-invasive robotic gynecologic surgery. MATERIAL AND METHODS We performed a retrospective review of data from 765 consecutive minimally-invasive robotic-assisted surgeries performed by high-volume gynecologic oncologists. The patients were divided into "younger" patients aged <65 years and "older" patients aged ≥65 years. The primary outcomes were intraoperative and postoperative complications. RESULTS Of the 765 patients analyzed, 185 (24%) were ≥ 65. The intraoperative complication rate in patients <65 was 1.9% (11/580) versus 1.62% (3/185) in females ≥65 (p = 0.808). The postoperative complication rate in patients <65 was 15.5% (90/580) versus 22.7% (42/185) in females ≥65 (p = 0.328). We observed more post-operative complications with patients who had intraoperative complications compared to patients who developed post-operative complications without intraoperative complcations in our sample, but it was not statisticaly significant (OR = 2.78, p = 0.097). The average estimated blood loss was 137.5 ml (0-1000) for patients younger than 65 years and 134.81 ml (0-2200) in patients 65 years or older (p = 0.097). DISCUSSION Robotic gynecologic oncology surgery is common. When performed by expert surgeons, complications are not associated with increasing age.
Collapse
Affiliation(s)
- Madison S Moore
- Arizona Oncology (US Oncology Network), Phoenix, AZ, United States of America
| | - Elise H Vo
- Creighton University School of Medicine at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Bikash Bhattarai
- Creighton University School of Medicine at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America; Maricopa Integrated Health System, Phoenix, AZ, United States of America
| | - John H Farley
- The University of Arizona College of Medicine, Phoenix, AZ, United States of America; Creighton University School of Medicine at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Bradley J Monk
- The University of Arizona College of Medicine, Phoenix, AZ, United States of America; Creighton University School of Medicine at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America; Maricopa Integrated Health System, Phoenix, AZ, United States of America; HonorHealth Research Institute, Phoenix, AZ, United States of America
| | - Lyndsay J Willmott
- The University of Arizona College of Medicine, Phoenix, AZ, United States of America; Creighton University School of Medicine at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America; Maricopa Integrated Health System, Phoenix, AZ, United States of America; Arizona Center for Cancer Care (Virginia Piper Cancer Care Network), Phoenix, AZ, United States of America
| | - Dana M Chase
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
| |
Collapse
|
2
|
Abstract
Objective: To investigate the assessment of feasibility and safety of laparoscopic decortication of simple renal cysts in elderly patients.Methods: The data of 114 patients who underwent laparoscopic decortication for simple renal cyst between October 2011 and May 2019 were retrospectively evaluated. Patients' age, gender and ASA scores; operation time; cyst size and location; complications; hospital stays and success rates of operations were recorded.Results: The mean age of the patients were 73.8 ± 8.2 years. Forty-eight (42.1%) of the patients were female and 66 (57.9%) were male. Cysts were localized on the right side in 61 (53.5%) patients and on the left side in 53 (46.5%) patients; and mean cyst size was 72.83 ± 31.13 mm. Also, they were localized on the anterior in 88 (77.2%) patients and on the posterior of the kidney in 26 (22.8%) patients. Preoperative ASA score distributions were ASA-I in 12 patients (10.5%), ASA-II in 31 patients (27.2%), ASA-III in 68 patients (59.7%), and ASA-IV in 3 patients (2.6%). Mean operative time was 41.4 ± 5.6 min. Clavien grade 1 complications were observed in 5 (10.4%) patients. Median hospitalization time was 1 day. No recurrence was occurred in any patient in the postoperative period.Conclusions: Although laparoscopic surgery has some risks and complications for elderly patients, laparoscopic decortication can be applied safely and effectively in treatment of simple renal cyst in that patient population.
Collapse
Affiliation(s)
- Ali Akkoç
- Department of Urology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Alanya, Turkey
| | - Cemil Aydın
- Department of Urology, Faculty of Medicine, Hitit University, Corum, Turkey
| |
Collapse
|
3
|
Ramos LPJ, Araújo RB, Castro MDOCV, Ramos MRMS, Cunha-E-Silva JA, Iglesias AC. Hemodynamic evaluation of elderly patients during laparoscopic cholecystectomy. ACTA ACUST UNITED AC 2018; 45:e1659. [PMID: 29846461 DOI: 10.1590/0100-6991e-20181659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/01/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to demonstrate hemodynamic changes during laparoscopic cholecystectomy in elderly patients with trans-esophageal echocardiography. METHODS we studied 31 elderly patients (aged 60 years or older), ASA I or II, who underwent elective laparoscopic cholecystectomy under general, standardized anesthesia, with cardiovascular parameters measured using transesophageal echocardiography at three different times: before the pneumoperitoneum (T1), after CO2 insufflation (T2) and at deflation (T3). We statistically evaluated changes in systolic, diastolic and mean blood pressure, heart rate, cardiac output and index, and ejection fraction. RESULTS although small, only the diastolic blood pressure (DBP) and ejection fraction (EF) variations were statistically significant. The mean ± standard deviation of DBP in mmHg at the different times were: T1=67.5±10.3; T2=73.6±12.4; and T3=66.7±9.8. And for EF, in percentage (%) they were: T1=66.7±10.4; T2=63.2±9.9; and T3=68.1±8.4. There was no statistical correlation between hemodynamic variations, age and number of patients' comorbidities. CONCLUSION laparoscopic cholecystectomy causes few hemodynamic changes that are well tolerated by the majority of the elderly patients; prior impairment of ventricular function represents a threat in elderly patients during surgery; there appears to be a lower hemodynamic effect caused by the pneumoperitoneum than by the patient's positioning in a reverse Trendelemburg during surgery.
Collapse
|
4
|
Jędrzejewski E, Liszka M, Maciejewski M, Kowalewski PK, Walędziak M, Paśnik K, Janik MR. Age is not associated with increased surgical complications in patients after laparoscopic sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne 2018; 13:82-87. [PMID: 29643963 PMCID: PMC5890836 DOI: 10.5114/wiitm.2017.69129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/21/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Age is considered as a risk factor in bariatric surgery. The observation was made on the basis of results from studies where patients underwent different type of surgery, but laparoscopic sleeve gastrectomy (LSG) was not among them. It is necessary to reevaluate the association of age with adverse events in the group of patients after LSG. AIM To investigate the association of age with surgery-related adverse events in patients after LSG. MATERIAL AND METHODS Retrospective analysis of medical data was performed. The study involved 345 patients who underwent LSG in our institution between January 2013 and December 2014. The patients were subdivided by age into four groups according to quartiles. In 30-day follow-up adverse events were evaluated. We considered the presence of the following events as the endpoint of our study: death, medical events and surgical events. RESULTS In general, we observed adverse events in 36 (10.4%) patients. The mortality rate in our study was 0.59%. Nineteen events were surgical and 18 medical. In 1 patient a surgical event was associated with a medical event. Bleeding was the most common surgical event and was observed in 17 (4.9%) cases. Age was not associated with surgical events (OR = 1.032, 95% CI: 0.991-1.075, p = 0.33) or medical events (OR = 0.997, 95% CI: 0.956-1.039, p = 0.89). CONCLUSIONS The LSG is a safe bariatric procedure with low mortality. Bleeding is the most frequent surgical complication. Our findings suggest that age is not associated with increased risk of surgical or medical adverse events after LSG.
Collapse
Affiliation(s)
- Emil Jędrzejewski
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Maciej Liszka
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Marcin Maciejewski
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Piotr K Kowalewski
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Maciej Walędziak
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Krzysztof Paśnik
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Michał R Janik
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| |
Collapse
|
5
|
Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA. Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66,483 patients. Surg Endosc 2014; 29:322-33. [PMID: 24986017 DOI: 10.1007/s00464-014-3672-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/06/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Increasing life expectancy requires specific attention on geriatric patients. Data support a potential reduction of surgical morbidity for patients undergoing laparoscopic surgery as compared to conventional surgery. The aim of this study was to investigate the comparative effect of laparoscopic and open colorectal surgery on geriatric patients. METHODS A systematic review of electronic information sources was undertaken. Studies that provided outcome data on patients aged 65 years or older, subjected to laparoscopic or open colorectal surgery, were considered. Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect. The methodological quality of selected studies was independently appraised by two reviewers. Random effects model was applied to synthesize outcome data. RESULTS Twenty-seven articles providing data for 66,592 patients were included in the analysis. Patients undergoing laparoscopic surgery had a decreased risk for mortality (2.2 vs. 5.4 %; OR 0.55, 95 % CI 0.44-0.67), overall morbidity (19.3 vs. 26.7 %; OR 0.54, 95 % CI 0.46-0.63), cardiac (4.7 vs. 7.7 %; OR 0.60, 95 % CI 0.39-0.92) and respiratory complications (3.9 vs. 6.3 %; OR 0.67, 95 % CI 0.47-0.95). Sensitivity analysis including reports with similar age, American Society of Anesthesiologists score and/or similar prevalence of cardiopulmonary morbidity between the laparoscopic and the open treatment arm validated the outcome estimates of the primary analysis. CONCLUSIONS This analysis supports a substantial benefit for elderly patients undergoing laparoscopic in comparison with open colorectal surgery. The comparative effect of either approach on geriatric patients with pulmonary and cardiac comorbidities is a subject of further investigation.
Collapse
|
6
|
Eddib A, Hughes S, Aalto M, Eswar A, Erk M, Michalik C, Krovi V, Singhal P. Impact of Age on Surgical Outcomes after Robot Assisted Laparoscopic Hysterectomies. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ss.2014.53018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
7
|
Permpongkosol S. Urologic Laparoscopic Surgeries in Elderly: Analysis of Pre-Operative Risk Factors and Postoperative Complications. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/oju.2013.35036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
8
|
Di Centa I, Coggia M, Cochennec F, Alfonsi P, Javerliat I, Goëau-Brissonnière O. Laparoscopic abdominal aortic aneurysm repair in octogenarians. J Vasc Surg 2009; 49:1135-9. [PMID: 19307083 DOI: 10.1016/j.jvs.2008.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 11/09/2008] [Accepted: 12/03/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Open abdominal aortic aneurysm (AAA) repair in octogenarians is considered to have higher risks of mortality and systemic complications compared with younger patients. The purpose of our work is to present our experience with total laparoscopic repair for AAA in this subset of patients. METHODS From February 2002 to February 2008, 29 octogenarian patients underwent total laparoscopic AAA repair. Median age was 82 years (range, 80-85 years). Median aneurysm size was 52 mm (range, 40-85 mm). Disease was classified as American Society of Anesthesiologist (ASA) class II in 12 patients and class III in 17 patients. Ten patients presented with past medical history of myocardial infarct (34.5%). RESULTS We implanted 12 tube grafts and 17 bifurcated grafts. Twenty-six procedures were totally laparoscopic (89.6 %). Median operative time and aortic clamping time were 280 min (range, 160-480 min) and 75 min (range, 22-125 min), respectively. Two patients with juxtarenal AAA underwent suprarenal clamping. Median blood loss was 1100 cc (range, 600-3000 cc). Four patients (13.8%) needed adjunctive vascular procedures because of intraoperative complications. Two patients died in the postoperative course (6.9%). Four patients developed severe systemic non-lethal complications (14.8%, pneumopathies). Mild or moderate systemic complications were observed in 14 patients (51.8%) including transient renal insufficiencies without dialysis (13) and cardiac arrhythmia (1). Postoperative creatinine levels returned to baseline before discharge in all patients. Liquid diet was reintroduced after a median duration of 2 days (range, 1-10 days) and most patients were ambulatory by day four (range, 3-30 days). Median stays in intensive care unit and hospital were 72 hours (range, 12-1368 hours) and 11 days (range, 6-74 days), respectively. Sixteen patients (59.2%) were discharged directly to home with complete recovery. After a median follow-up of 24 months (range, 2-48 months), 23 patients are still alive and regained their baseline status. Four patients died after hospital discharge of non-vascular etiologies. CONCLUSION Total laparoscopic AAA repair is a worthwhile but challenging procedure in octogenarians. Laparoscopy is complementary to open surgery and EVAR in this subset. These results encourage us to offer laparoscopic AAA repair in good surgical risk octogenarians.
Collapse
Affiliation(s)
- Isabelle Di Centa
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris, the Faculté de Médecine Paris-Ile de France-Ouest, Versailles Saint Quentin en Yvelines University, Boulogne-Billancourt, Paris
| | | | | | | | | | | |
Collapse
|
9
|
Affiliation(s)
| | - Stephan Renner
- Universitätsklinik Erlangen, Frauenklinik, Erlangen, Germany
| | | | | |
Collapse
|
10
|
Abstract
OBJECTIVE To describe our experience with laparoscopic renal surgery (LRS) in the octogenarian. Octogenarians are generally suboptimal surgical candidates but the recent upsurge of minimally invasive options for the management of kidney lesions, such as laparoscopic excision, cryoablation and radiofrequency ablation (RFA), have changed that perception. PATIENTS AND METHODS In all, 26 patients aged >or=80 years underwent LRS at Brown University and the University of Wisconsin between 2000 and 2006. Demographic information, anatomical location, tumour stage, comorbidities, type of laparoscopic approach, management and outcomes were assessed. Complications during and after LRS, hospital stay, analgesia requirements and return to normal activity were analysed. RESULT The mean age of the patients was 81 years. The procedures performed included hand-assisted laparoscopic partial nephrectomy (three patients), hand-assisted laparoscopic radical nephrectomy (10), hand-assisted laparoscopic nephroureterectomy (four), laparoscopic-assisted cryoablation (seven), laparoscopic RFA (one), and laparoscopic unroofing of a renal cyst (one). The mean (range) follow-up was 40 (8-84) months. The mean American Society of Anesthesiologists score was 2.5. The average hospital stay was 5.6 days and the mean time to normal activity after discharge was 19 days. There were two major and five minor complications. Nineteen of 22 patients evaluable had no evidence of disease at the last follow-up. The three deceased patients died of unrelated causes. CONCLUSION LRS in the octogenarian is safe to perform in patients with multiple comorbidities. The major and minor complication rates were 7% and 19%, respectively. Recent trends show that ablative procedures are being performed more commonly than surgical excision in this age group.
Collapse
Affiliation(s)
- Gyan Pareek
- Division of Urology/Department of Surgery, Warren Alpert School of Medicine at Brown University, Providence, RI 02905, USA.
| | | | | | | | | |
Collapse
|
11
|
Cheng SP, Chang YC, Liu CL, Yang TL, Jeng KS, Lee JJ, Liu TP. Factors associated with prolonged stay after laparoscopic cholecystectomy in elderly patients. Surg Endosc 2007; 22:1283-9. [DOI: 10.1007/s00464-007-9610-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 08/09/2007] [Accepted: 09/22/2007] [Indexed: 12/13/2022]
|
12
|
Abstract
The current concepts on diagnosis, clinical features, and management of common gastrointestinal conditions in the elderly population, taking into account physiological aspects of ageing, are evaluated. Gastrointestinal (GI) disorders are discussed with an emphasis on oesophageal problems, Helicobacter pylori infection, malabsorption, diverticular disease, and cancer. GI problems are acquiring greater importance in hospitals and in the community and their incidence is increasing. Newer treatments have less impact on patients' wellbeing and meticulously planned investigation and treatment is needed. Careful selection of patients and application of modern techniques has improved survival and outcomes, with comparable results to those in younger age groups.
Collapse
Affiliation(s)
- A L D'Souza
- Care of the Elderly, Imperial College Faculty of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
| |
Collapse
|
13
|
Matin SF, Abreu S, Ramani A, Steinberg AP, Desai M, Strzempkowski B, Yang Y, Shen Y, Gill IS. Evaluation of age and comorbidity as risk factors after laparoscopic urological surgery. J Urol 2003; 170:1115-20. [PMID: 14501704 DOI: 10.1097/01.ju.0000086091.64755.ac] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Few reports in the urological literature have focused on the growing population of elderly (65 years or older) patients. Coexistent medical conditions, which are more prevalent in elderly individuals, can confound results of outcome studies in this population. This single center, retrospective study was done to determine whether age and comorbidity are predictors of outcome in patients undergoing laparoscopic renal and adrenal surgery. MATERIALS AND METHODS From 1997 to 2001 laparoscopic radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy were performed in 399 consecutive adults. Patient demographics and preoperative, intraoperative and postoperative parameters were extracted from a prospectively designed computerized database. Risk stratification was based on preoperative American Society of Anesthesiologists (ASA) score. Additional risk stratification was constructed using the Charlson comorbidity index. Univariate and multivariate analyses were also performed. RESULTS Age 65 years or older was not associated with an increased incidence of intraoperative, postoperative or late operative complications on univariate or multivariate analyses. However, patients 65 years or older were hospitalized significantly longer than those younger than 65 years (43 vs 24 hours, p = 0.02). Blood loss and the requirement for blood transfusion were associated with longer operative time, a higher incidence of intraoperative and postoperative complications on univariate analysis, and longer hospitalization. No association of blood loss with postoperative complications was noted on multivariate analysis. Patients with a higher ASA score were more likely to receive blood transfusion. On univariate analysis risk stratification using the ASA score and the Charlson comorbidity index was not associated with intraoperative or postoperative complications. However, on multivariable analysis patients with the lowest indexes were less likely to experience postoperative complications than those with the highest indexes (less than vs greater than 3, p = 0.04). The comorbidity index had a marginal association with the incidence of late complications (p = 0.06). CONCLUSIONS Laparoscopic renal and adrenal surgery in patients 65 years or older is well tolerated. Age 65 years or older is predictive of a significantly increased hospital stay of approximately 1 day after major renal and adrenal laparoscopic surgery and it does not appear to increase independently the risk of intraoperative, postoperative or late operative complications.
Collapse
Affiliation(s)
- Surena F Matin
- Urological Institute, Cleveland Clinic Foundation, Ohio, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Mateo RB, Sher L, Jabbour N, Singh G, Chan L, Selby RR, El-Shahawy M, Genyk Y. Comparison of Outcomes in Noncomplicated and in Higher-Risk Donors after Standard versus Hand-Assisted Laparoscopic Nephrectomy. Am Surg 2003. [DOI: 10.1177/000313480306900908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hand-assisted techniques facilitated dissemination of the laparoscopic approach in live kidney donors and addressed concerns regarding potential procedural complications. We report our experience with both standard and hand-assisted laparoscopic nephrectomy in routine, complicated, and higher-risk donors. From July 1999 to September 2002, 47 donors underwent standard laparoscopic donor nephrectomy (SLDN; n = 29) or hand-assisted laparoscopic donor nephrectomy (HALDN; n = 18). Donors were “complicated” if they were >60 years of age, obese, refused blood-product transfusion, had multiple renal arteries or veins, or had right nephrectomies. “Higher-risk” donors had two or more risk factors. Results for SLDN and HALDN were compared for the overall groups and for the “complicated” and “higher-risk” groups. No donor required blood transfusion or reoperation. Warm-ischemia times were shorter in left nephrectomies (191 ± 72 seconds vs. 337 ± 95 seconds, P = 0.005), and blood loss was greater in patients with a body mass index ≥30 kg/m2 (296 ± 232 mL vs. 170 ± 139 mL, P = 0.03). Higher-risk donors had an increased operative blood loss and longer hospital stay than low-risk donors. Mean donor creatinine at discharge was 1.19 ± 0.2 mg/dL. Comparison of SLDN versus HALDN revealed shorter operating times for the latter, which approached statistical significance. Warm-ischemia time, operative blood loss, length of hospitalization, and donor and recipient discharge creatinines were similar for both groups. Laparoscopic donor nephrectomy can be applied to selected higher-risk donors with outcomes comparable to uncomplicated donors. Hand-assisted techniques facilitate the procedure during the learning curve, with advantages similar to standard laparoscopic techniques.
Collapse
Affiliation(s)
- Rod B. Mateo
- Department of Surgery, Division of Hepatobiliary/Pancreatic and Abdominal Transplant Surgery
| | - Linda Sher
- Department of Surgery, Division of Hepatobiliary/Pancreatic and Abdominal Transplant Surgery
| | - Nicolas Jabbour
- Department of Surgery, Division of Hepatobiliary/Pancreatic and Abdominal Transplant Surgery
| | - Gagandeep Singh
- Department of Surgery, Division of Hepatobiliary/Pancreatic and Abdominal Transplant Surgery
| | - Linda Chan
- Department of Surgery, Division of Biostatistics; Department of Medicine
| | - Robert R. Selby
- Department of Surgery, Division of Hepatobiliary/Pancreatic and Abdominal Transplant Surgery
| | - Mohamed El-Shahawy
- Department of Surgery, Division of Nephrology, Keck/USC School of Medicine, Los Angeles, California
| | - Yuri Genyk
- Department of Surgery, Division of Hepatobiliary/Pancreatic and Abdominal Transplant Surgery
| |
Collapse
|
15
|
Abstract
As the population survives longer, surgery has become a much more common consideration. Preoperative management of these patients requires a working knowledge of changes associated with aging and the physiology of surgery and anesthesia. Using this information, patients can be clinically evaluated effectively and plans made for their perioperative care to minimize complications.
Collapse
Affiliation(s)
- Margaret M Beliveau
- Division of General Internal Medicine, Mayo Clinic, 200 First Street, South West, Rochester, MN 55905, USA.
| | | |
Collapse
|